Florida Dental Group Provides Care to the Homeless

February 21, 2014

As Florida dentists prepare for the first two-day, statewide event aimed at providing free care for the underserved, one dental group has created a model that extends care year-round.

The state's first Mission of Mercy program, hosted by the Florida Dental Association through the Florida Dental Health Foundation, is expected to provide care for 1,600 to 2,000 patients on March 28-29. It targets underserved populations by amassing more than 300 dental practitioners and 1,000 support volunteers throughout the state in Tampa, where they will offer care to anyone who attends the event.

One of the event's co-chairs is Dr. Leo Cullinan, an orthodontist in Naples, Florida, who helped create a model for continual care that he hopes will inspire others in the profession.

Since 2009, comprehensive dental care has been provided for those who stay at St. Matthew's House, a local homeless shelter for men and women in nine-month recovery programs through the non-profit Dental Outreach of Collier, Inc., co-founded by Drs. Leo Cullinan and David O'Sullivan. While treating the homeless for a variety of oral health issues in a six-operatory clinic at the Lorenzo Walker Institute of Technology, participating dentists also provide the resident dental assisting students live patient experiences.

"Our goal within the nonprofit – and by extension within the West Coast District Dental Association – is to heighten awareness of the need and encourage our colleagues to volunteer their time and expertise," said Dr. Cullinan, who is the immediate past-president of the West Coast Dental Association, one of six components of the Florida Dental Association. "If the communities are made more aware, they tend to embrace the effort and support it financially. The more support we receive, the more people we can help with their dental needs."

Funding for the program, which has provided nearly $700,000 of care since its inception, is generated through grants and solicitations from private donors to cover the costs of dental supplies and lab fees. The volunteer providers are covered under the sovereign immunity provisions of Florida state statutes as long as the patients do not earn more than 200 percent of the federal poverty level, according to Dr. Cullinan.

"One of the advantages of working with the [ladies and] gentlemen in the recovery program is that we know they qualify financially and they understand that the cost to them is their time and patience," he said. "These patients are learning life, behavioral, and technical skills, as many are also enrolled as students at the Lorenzo Walker Institute of Technology. But they will have a difficult time getting hired with untreated dental conditions."

Dr. Cullinan also requires all patients scheduled for an afternoon appointment to report to the clinic at 1:30 p.m., ensuring there is never an empty chair throughout the afternoon session.

"We have a pool of patients, and this system increases our efficiency," he added.

Patients understand the importance of dentists sharing their experiences with students, who assist the volunteer dentists.

"They know that we are working with students and that if we come across a 'teachable' moment, we stop and help the students learn from the experience," added Dr. Cullinan.

While the comprehensive treatment model in the clinic setting is preferable, Dr. Cullinan recognized early on that some practitioners prefer to provide pro-bono treatment in their own offices. Among the primary challenges with this approach are the lack of an equitable referral system and ineffective communication and documentation.

To address this problem, Dr. Cullinan developed a dental management and referral software program called "Barn Raiser." This web-based, HIPAA-compliant application allows patients to be screened from any location with internet access. They are then referred to a private practitioner who agrees to see the patient in their office.

The dentist or dental specialist is notified of the details of the referral through email, the appointment is coordinated for the patient, and the provider logs back into the system and records the specifics and value of the care that was delivered.

Dr. Cullinan's team made the decision to provide comprehensive dental treatment for all patients during the early stages of forming Dental Outreach of Collier, Inc. This includes a medical clearance by a board-certified physician, complete diagnostic and preventive services, as well as the full spectrum of surgical and restorative services.

"We feel this is the only way to have any chance of engaging the patient and emphasizing their role in good oral health," he said. "If we are merely taking care of the 'chief concern,' then a tooth that could have been restored now may very well need to be [unnecessarily] extracted at some future date, which perpetuates the cycle of 'extraction-neglect-extraction.'"